Tooth decay is a major dental problem affecting children and adults across the globe. Worldwide dental decay has been a main dental problem in most of the developing countries including India. Tooth decay occurs in both milk dentition and permanent dentition in a man’s life. Tooth decay may result in sensitivity, pain and swelling. In children it has resulted in suffering for the child- pain, swelling, loss of school hours, financial burden and loss of productivity of the parents.
Causes for dental decay
Dental decay occurs by the interaction of 4 components-Tooth, Bacteria, Carbohydrates and Time. The oral cavity of a person contains millions of bacteria. The bacteria act upon the carbohydrates present over the tooth surface and results in the production of acid. This acid acts upon the enamel of the tooth resulting in loss of minerals from it and thereby resulting in tooth decay. The various etiological factors responsible for causing tooth decay are;
- Consumption of sweets/pastries/junk foods.
- Poor oral hygiene
- Bottle feeding at night
- Medication syrups containing sugar
- Crowding of teeth
- Dry mouth
- Diabetes
Progression of dental decay
In a tooth the first sign of dental decay presents as a white spot(loss of minerals) which is visualised only by a dentist on drying the tooth surface. The decay begins at the enamel(top layer of the tooth) and gradually penetrates the dentin(second layer of the tooth) and then progresses into the pup of the tooth. When decay involves the dentin it may result in sensitivity in the patient. When the decay has involved the pulp, it may result in pain/swelling/infection.
Types of dental decay
Based on the site of occurrence it has been classified into;
- Crown caries- The decay can start at the occlusal/buccal/lingual/interdental surface of the tooth. This type of dental caries is usually seen in children and adults.
- Cervical caries- This type of dental decay occurs at the junction between the crown and the root of the tooth. This type of caries is commonly seen among adults and elderly patients.
- Root caries- This is a type of dental decay which occurs at the root surface of the tooth. This type of decay is seen in elderly patients where gingival recession has occurred thereby the root of the tooth is exposed in the oral cavity.
Dental decay in children
Baby bottle tooth decay is a disease characterized by severe decay in the teeth of infants or young children. Early childhood caries are a very common bacterial infection. The disease process begins with the transmission of the bacteria to the child, usually from the primary caretaker. Caretakers with untreated dental disease present a very high risk to their children.
Frequent consumption of liquids containing fermentable carbohydrates (e.g., juice, milk, formula, soda) increases the risk of dental caries due to prolonged contact between sugars in the liquid and cariogenic bacteria on the teeth. Frequent bottle feeding at night, and extended and repetitive use of a no-spill training cup are associated with baby bottle decay.
Decay occurs when sweetened liquids are given and are left clinging to an infant's teeth for long periods. Many sweet liquids cause problems, including milk, formula and fruit juice. Bacteria in the mouth use these sugars as food. They then produce acids that attack the teeth. Each time your child drinks these liquids, acids attack for 20 minutes or longer. After many attacks, the teeth can decay. The lower incisors are usually not affected due to the presence of saliva and cleansing effect of the tip of the tongue.
Rampant caries
Rampant caries is a suddenly appearing, rapidly burrowing type of caries resulting in early pulp involvement, in which more than 10 new lesions appear every year on healthy teeth surfaces which are generally immune to caries. It occurs in children of any age group and can involve both primary and permanent teeth and occurs as a result of consumption of sugary foods and decreased salivation. It involves all teeth including the lower incisors.
Treatment
The treatment for dental decay in children depends on the extent of decay in the tooth. Milk teeth- If the decaying has occurred in the milk teeth involving the enamel or dentine it can be saved by doing a restoration over the tooth. If the decay has involved the pulp it can be treated by pulpotomy/pulpectomy. If the tooth cannot be saved it should be extracted.
Permanent teeth- Dental decay involving the enamel and dentin should be treated by placing a restoration over the tooth. If the decay has involved the pulp, it can be treated by root canal treatment(RCT) followed by placement of crown over the tooth. Tooth which is grossly decayed and deemed unrestorable by the dentist should be extracted.
Prevention
- Brush your teeth using fluoridated tooth paste twice daily especially before retiring to bed. Use only a handful of water to rinse the mouth after brushing teeth.
- Floss your teeth atleast once a day.
- Change your tooth brush once in 3 months.
- Consult your dentist once in 6 months to identify for any signs of dental decay.
- Undergo scaling of teeth by your dentist once in 6 months.
- Do not feed your child with bottle containing sweet juices/milk during sleep.
- In infants, the parent should wipe the gum pads/teeth using sterile gauze/cloth after every feed.
- Use a fluoride mouth wash as per the advice of your dentist.
- Do not consume sweets at meal times.
- In children who are susceptible to dental decay, pit and fissure sealants and topical fluoride application should be done by your dentist to prevent dental decay.
- Malocclusion of teeth should be treated by undergoing orthodontic treatment to prevent accumulation of food deposits between teeth which cannot be cleansed by routine tooth brushing.
- Consume foods rich in calcium, phosphorous, vitamins and proteins for a healthy oral cavity.
The best treatment of dental decay is to prevent it from occurring. It is very important is prevent dental decay both in milk and permanent teeth. Home care measures should be taught to the child at the early age itself to prevent dental decay. Preventive measures like pit and fissure sealants and topical fluoride application are effective in preventing dental decay in children.
